It’s not unusual for Nick Vargas, president of The Source LGBT+ Center in Visalia, to hear some of the center’s older members express concern about what will happen to them when they reach the age where they need to transition to senior housing.

Though they rocked cultural norms by being open about their sexuality in their youth, these lesbian, gay, bisexual and transgender (LGBT) elders, often find that moving into an assisted living or skilled nursing facility means going back into the closet. In rural and more conservative areas of the state, and across the country, many LGBT seniors report difficulties finding affordable, affirming housing options and say they often face discrimination and intimidation from staff and other residents in traditional senior-living settings.

Nationally, an estimated 1.5 million LGBT people are 65 or older, and that number is projected to double by 2030—yet only a handful of senior communities cater to the specific needs of older members of the LGBT community. In Visalia, Vargas said, there is only one senior residential facility that is openly inclusive of LGBT seniors, but it is high-end housing that proves too costly for many.

“LGBT seniors are often faced with having to choose between senior housing that is welcoming but high-priced, or traditional and more affordable senior communities where they may believe they need to go back into the closet in order to feel safe and receive good care,” Vargas said.

As a result, he’s seen LGBT seniors who have opted to move to less-costly areas in other states, or to hide their sexuality in order to avoid discrimination and to ensure they receive the services they need.

‘They didn’t know how to respond’

Many LGBT seniors also don’t have a strong familial support system. According to a March 2010 report posted on the website of the National Resource Center on LGBT Aging, many LGBT elders end up relying on nursing homes or other institutions that provide long-term care as they are more likely to be single, childless or estranged from their biological family.

Van Vanlandingham, 69, of Porterville felt he needed to keep his sexual orientation a secret after being discharged from a hospital to a local nursing home after a complicated knee surgery in early 2016.

“Shortly after I arrived, the staff began asking if I was married and when my wife would be coming to visit,” he recalled. “I said I was a widower and they asked what my wife’s name was. When I said Dustin, the conversation ended. They didn’t know how to respond.”

Vanlandingham, who had been with Dustin for 38 years before he passed away, felt he couldn’t be open about his identity with the rehab center staff members. It became worse when he was transferred into a room with two men who made homophobic comments.

“They were both on parole from prison and talked about how they treated a queer guy in prison,” Vanlandingham said. “I was too weak to defend myself, so I stayed silent.”

Vanlandingham asked workers if there was another room he could transfer to in the facility, but he was told there was not.

“They didn’t have any policies or training in place on how to care for LGBT elders,” Vanlandingham said. “I vowed that as soon as I was discharged, I would return and offer a workshop that would give staff a better understanding on how to support older LGBT people.”

Trainings Promote Inclusivity

To eliminate housing discrimination because of sexual orientation and gender identity, LGBT advocates said senior residential communities must adopt a zero tolerance policy for discriminatory behavior.

Hilary Meyer, chief enterprise and innovation officer at Services and Advocacy for LGBT Elders (SAGE) in Los Angeles, said her organization provides a list of LGBT-friendly senior housing projects that encompass all levels of care, ranging from independent living to skilled nursing.

In addition, to increasing the number of senior living communities who work to make LGBT residents feel safe and comfortable, Meyer said SAGE offers cultural competency trainings called SAGECare to residential health-care providers, government agencies that offer program funding, home health-care and hospice companies, and nonprofits across the country.

Vanlandingham used the SAGECare curriculum when he returned to the rehab center a few months after being a patient there. He hoped to help staff members understand LGBT aging issues and create a more inclusive and welcoming community.

“All of the staff members were very apologetic after the training,” Vanlandingham said. “For many, it wasn’t that they were anti-LGBT, but rather they didn’t know how to carry on a conversation with someone who identified as LGBT.”

Vanlandingham used his own experiences to explain how he and his partner had adopted three children, and that the same questions that applied to other senior residents also applied to him.

“I explained that LGBT elders want to be asked about their lives, interests, families and careers,” he said. “We’re not different than anyone else.”

In addition to some teachers like Vanlandingham who weave their personal experiences into the workshops, SAGECare’s cultural competency trainings also give guidance on LGBT aging issues and extend the added benefit of offering qualifying agencies a national credential to highlight the percentage of staff trained.

The trainings give staff members a chance to ask questions ranging from “Can AIDS be spread by kissing?” to “How do you become gay?” and cover topics including what services are needed to care for transgender elders, how to ask open-ended questions about a person’s relationship status and how to refer to seniors by the pronouns they prefer.

As a result of the trainings, Meyer said some senior communities have added programming, such as an LGBT movie shown in June, which is LGBT pride month.

“After the movie, they’ll have a guided discussion and the feedback they typically receive from residents is overwhelmingly positive,” Meyer said. “Some residents have kids and grandchildren who identify as LGBT, so these discussions can increase their understanding of the community as a whole.”

Bill Would Combat Discrimination

In 2015, California enacted legislation to provide LGBT cultural competency for medical providers. The law works to ensure that physicians and surgeons receive continuing medical education to increase cultural competency in their work with LGBT patients. 

In February, California Senator Scott Wiener (D-San Francisco) introduced legislation that would address the housing challenges faced by LGBT seniors. A former member of the San Francisco Board of Supervisors, Wiener introduced Senate Bill 219, the California LGBT Seniors Long-Term Care Bill of Rights, which will strengthen protections for LGBT seniors living in long-term care facilities.

The bill aims to protect seniors from discrimination based on sexual orientation, gender identity, gender expression or HIV status. The bill would apply to all seniors living in skilled nursing facilities, immediate care facilities and residential care facilities.

If the bill is released by the senate Appropriations Committee this month, it will move to the Senate for a vote in early June, Weiner’s office said.

“Our LGBT seniors were at the front lines of so many battles to expand our civil rights,” Wiener said. “They deserve to age with dignity and respect, and that means making sure our long-term care facilities have culturally competent policies and procedures in place.”